Malignant Hyperthermia

 

First things:

Recognise

·      Unexplained ↑etCO2 (early)

·      Unexplained ↑temp (later)

·      Associated: rigidity, ↑HR, ±↑BP, ↑Lactate, ↑K+

Call for help

·      Buzzer

·      MH trolley

·      Role allocation

 

Primary jobs:

1.Remove trigger

·      Volatile off

·      Flush circuit (10L/min)

·      Propofol TIVA

2.Give dantrolene

·      20mg vial into 60mL sterile water

·      2.5mg/kg = 180mg = 9 vials = 540mL

·      Repeat q10mins, max 10mg/kg = 4 rounds

·      Continue 1mg/kg q6h for 24h

3.Active cooling

·      Exposure

·      Ice packs

·      Forced air

·      Lavage

·      Aim 38°C

 

Secondary jobs:

Resuscitation

·      A: ETT

·      B: IPPV

·      C: A-line, CVC, IDC

·      Tests: ABG, FBE, UEC, CMP, CK

Treat complications

·      Hyperkalaemia

·      Arrhythmias

·      Metabolic acidosis

 

Afterwards:

Follow up

·      MH alert form

·      Referral for patient and family

·      M&M

·      Theatre debrief

Next time

·      No vapourisers

·      No sux

·      Change CO2 absorber

·      Flush circuit 10L/min 1 hour

 

 

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